AB0977 THE RELATIONSHIP OF OVERWEIGHT AND CONCOMITANT METABOLIC DISORDERS WITH THE FEATURES OF THE COURSE OF PRIMARY OSTEOARTHRITIS OF THE KNEE JOINTS
Authors: I. Bashkova, I. Madyanov, K. Misko
Journal: Annals of the Rheumatic Diseases (2022)

Background There are two theories of the relationship between osteoarthritis (OA) and obesity: biomechanical and metabolic. Objectives To study the prevalence of overweight and obesity and concomitant metabolic disorders in patients with OA and to assess their impact on the features of the course of primary OA of the knee joints. Methods Patients with primary OA with a lesion of the knee joints (n = 90, including 22 men) were examined. The age of the patients is 29-69 years, the duration of the disease is 1.5-20 years. The control group (n = 114, including 26 men) was formed by random sampling of the population from practically healthy people, it is representative by gender and age. Anthropometric examination, determination of lipid metabolism parameters, levels of dehydroepiandrosterone sulfate (DHEA-C) and cortisol in the blood, X-ray and arthrosonographic examination of joints were performed. The functional state of the knee joints was analyzed by the Lequesne gonarthrosis severity index and the WOMAC algofunctional index. Results Average Body Mass Index (BMI) in patients, OA was 28.6±5.8 kg/m 2 and was slightly higher than in the control group (27.6±4.5 kg/m 2 , p&gt;0.05). Overweight and obesity were detected, respectively, in 40.7% and 33.0% of patients with OA, and in 43.0% and 28.9% of the control group. An increase in BMI in patients with OA, despite the absence of a significant difference in age and duration of the disease, is accompanied by an increase in the total values of the WOMAC index (p=0.042) and Lequesne (p=0.038). According to arthrosonography, the increase in BMI is directly related to an increase in the size of osteophytes (r=+0.43, p=0.003) and inversely correlates with the width of the articular gap of the medial knee joints (r=-0.37, p=0.014). Knee synovitis was detected in 5 patients out of 24 people (20.8%) with normal body weight, in 11 patients out of 37 people (29.7%) who are overweight, and in 13 patients out of 30 people (43.3%) who are obese of varying severity (p&gt;0.05). Synovitis of the knee joints in most cases was detected in patients with OA with an abdominal type of fat distribution. The negative influence of the abdominal type of fat distribution on the course of knee joint OA was revealed: positive correlations between waist circumference and the total Lequesne index (r=+0.443, p=0.027), and the radiological stage of OA (r=+0.467, p=0.019). In patients with OA with abdominal type of fat distribution, the severity of joint pain during exercise was 33.3% higher than in patients with gluteofemoral type (p&lt;0.001), the total Lequesne and WOMAC indices were 27.2% (p=0.028) and 20.1% (p=0.041), respectively. In patients with OA, a significant increase in the blood content of cholesterol (HC) of low-density lipoproteins (LDL) was found (p=0.039) and a decrease in high-density lipoprotein (HDL) cholesterol (p=0.046). Disorders of lipid metabolism of atherogenic orientation were more pronounced in patients with III-IV radiological stages of gonarthrosis. In patients with OA who are overweight or obese, the serum DHEA-C content was lower than in patients with OA with normal body weight (2.31±0.98 mcg/ml vs 2.63±1.68 mcg/ml, p&gt;0.05). As the radiological changes in the joints progress, there is a clear decrease in the concentration of DHEA-C. In women with OA, a significant relationship was found between waist circumference and the concentration of DHEA-C in the blood (r=-0.321, p=0.045). There was an increase in the concentration of cortisol in the blood of patients with OA. The inverse correlation relationship between the number of swollen joints with the blood content of DHEA-C (r=-0.269, p=0.012) and cortisol (r=-0.232, p=0.028) was revealed. Conclusion The mechanisms of the negative effect of overweight and obesity on the course of OA are lipid disorders (high concentrations of LDL cholesterol, low HDL cholesterol), hormonal changes (low DHEA-C, elevated cortisol levels) and the production of proinflammatory cytokines by adipose tissue. Disclosure of Interests None declared